Public Data Source Map

The federal data backbone behind JIL's five product lines.

Free, no-DUA federal data assets - NPPES, LEIE, SAM, HCRIS, NCD/LCD, CERT FY2024, Open Payments, OFAC SDN, Provider+Service summaries - mapped to the JIL Sovereign product surface. Beneficiary-level claims at scale require an LDS DUA; the public stack is sufficient for the entity, rule, and pattern layers.

Federal data sources

CERT FY2024 detectors

MAC jurisdictions

Product lines

Five product lines, one data backbone

What each line does and the public data that powers it.

Pre-Settlement block

Detects improper claims before the payer settles.

Real-time validation against provider eligibility, coverage rules, coding rules, and known error patterns.

NPPES NPI Registry
OIG LEIE (excluded individuals/entities)
SAM.gov entity exclusions
CMS Preclusion List (MA / Part D)
NCD / LCD via Medicare Coverage Database
HCPCS / CPT / ICD-10 code sets
CERT FY2024 root-cause library 26 detectors seeded
SynPUFs synthetic claims

Retroactive recover

Look-back: provider, HCPCS, and geographic outliers.

Per-NPI Z-scores against national and state benchmarks. The math behind the recoverable-improper-payment narrative.

Physician + Other Practitioners by Provider and Service (NPI x HCPCS)
Physician + Other Practitioners by Geography and Service
Inpatient Hospitals by Provider and MS-DRG
Outpatient Hospitals by Provider and APC / HCPCS
Part D Prescriber by Provider and Drug
Hospice / HHA / SNF / DMEPOS provider summaries

Asset Intel ownership

Entity ownership, related parties, capital structure.

HCRIS cost reports include "Medicare settlement data" and the related-party transaction worksheets that expose self-dealing and shell vendors.

HCRIS cost reports (HOSP10, SNF, HHA, Hospice, RHC, FQHC)
PECOS provider enrollment + ownership chain
Provider of Services (POS) file
CMS Open Payments (Sunshine Act)
IRS Form 990 (nonprofit hospitals)

Wallet Intel resolve

Resolve federal bad-actor names to wallets.

"We start with the names the federal government has already proven are bad. We then resolve those names to the wallets they actually use."

OIG LEIE
OIG Enforcement Actions
DOJ Healthcare Fraud Strike Force
HHS-OIG Most Wanted Fugitives
OFAC SDN List
SAM.gov entity exclusions

Pre-Clearance approve

Front-door integrity: before the claim is even submitted.

"This claim will fail CERT root-cause #X under LCD L#####, valid 2025-04-01 to present, in MAC jurisdiction Y." Same language an appeals body would use.

Medicare Coverage Database (NCDs and LCDs)
LCD Articles - HCPCS-to-diagnosis mappings, frequency rules
Prior Authorization Required Lists (DMEPOS, OPD, Home Health)
HCPCS / CPT / ICD-10 code sets
MAC LCD Jurisdiction Map
NPPES + LEIE + SAM clearance check

All sources we ingest

Cadence, format, DUA requirement.

Source	Lines	Cadence	DUA	Format
NPPES NPI Registry	PSRTAIWIPC	Weekly	No	CSV
OIG LEIE	PSWIPC	Monthly	No	CSV
SAM.gov Entity Exclusions	PSWIPC	Daily	No	CSV
CMS Preclusion List	PSPC	Monthly	MAO-restricted	XLS
Medicare Coverage Database (NCD / LCD)	PSPC	Quarterly	No	XML
HCPCS / CPT / ICD-10	PSPCRT	Annual	CPT licensed (AMA)	XLS
CERT FY2024 Supplemental	PSRTPC	Annual	No	XLS / PDF
Physician + Other Practitioners by Provider and Service	RT	Annual	No	CSV
Physician + Other Practitioners by Geography and Service	RT	Annual	No	CSV
Inpatient Hospitals by Provider and MS-DRG	RT	Annual	No	CSV
Outpatient Hospitals by Provider and APC / HCPCS	RT	Annual	No	CSV
Part D Prescriber by Provider and Drug	RT	Annual	No	CSV
Hospice Utilization	RT	Annual	No	CSV
Home Health Agency by Provider	RT	Annual	No	CSV
SNF by Provider	RT	Annual	No	CSV
DMEPOS by Referring Provider	RT	Annual	No	CSV
HCRIS Cost Reports	AIRT	Quarterly	No	Flat
PECOS Enrollment	AIPSPC	Quarterly	No	CSV
Provider of Services (POS)	AI	Quarterly	No	CSV
CMS Open Payments (Sunshine Act)	AI	Annual	No	CSV
OIG Enforcement Actions	WI	Continuous	No	JSON
DOJ Healthcare Fraud Strike Force	WI	Continuous	No	JSON
HHS-OIG Most Wanted Fugitives	WI	Continuous	No	JSON
OFAC SDN List	WI	Daily	No	CSV
CMS SynPUFs	PSRTPC	Periodic	No	CSV
Prior Authorization Required Lists	PC	Quarterly	No	XLS
MAC LCD Jurisdiction Map	PC	Quarterly	No	CSV
LDS Standard Analytic Files	RT	Quarterly	Yes	SAS / CSV

Recommended POC stack

Six layers, no DUA, ready in days.

Provider Risk Identity Index. NPPES + LEIE + SAM, refreshed daily.
Settlement Layer. HCRIS cost reports for the prospect's geography.
Utilization Layer. Physician by Provider + Service, plus Inpatient by MS-DRG, latest reference year.
Rule Layer. NCD / LCD set + CERT FY2024 root-cause library encoded as detectors.
Synthetic Demo Layer. SynPUFs for any walk-through that needs claim-level granularity.
cREB Output. Each detection emits a per-claim / per-entity evidence package, anchored to CourtChain, citing the exact federal data source, version, and effective date.

Public API

Hit any of these directly.

The CMS public-data stack exposes a single gateway at /api/cms. All endpoints are HTTP and return JSON.

Endpoint	Purpose
`GET /api/cms/sources`	List every federal data source we ingest, with cadence and last-fetched timestamp.
`GET /api/cms/providers/:npi`	Provider Risk Identity profile for a single NPI: NPPES + exclusions + Open Payments + enforcement actions.
`POST /api/cms/providers/check`	Bulk NPI check against LEIE + SAM + Preclusion. Up to 500 NPIs / call.
`POST /api/cms/detectors/evaluate`	Pre-Settlement evaluation - run a claim against CERT root causes + NCD/LCD coverage + prior-auth rules.
`POST /api/cms/coverage/check`	Pre-Clearance check: is HCPCS X covered for state Y on date Z?
`GET /api/cms/outliers/npi/:npi`	Per-NPI Z-score outliers vs. national or state benchmarks.
`GET /api/cms/asset-intel/ccn/:ccn`	HCRIS cost reports + related-party transactions for a CCN.
`POST /api/cms/bad-actors/match`	Wallet Intel: fuzzy-match a name against the federal bad-actor universe.

Standing infrastructure, day one. The first piece of plumbing JIL stands up is the daily LEIE / weekly NPPES ingestion job. Everything else hangs off that index.